Transmitted Human Immunodeficiency Virus Type 1 (HIV-1) Drug Resistance Among Newly Diagnosed Individuals in 31 Provincial-Level Administrative Divisions in China in 2023: A Cross-sectional Survey

Abstract Background Transmitted drug resistance (TDR) may compromise the effect of antiretroviral therapy (ART), highlighting the necessity for continuous monitoring. Methods The study was conducted across 31 provincial-level administrative divisions of China. Demographic information and blood samples were collected from participants at diagnosis of human immunodeficiency virus (HIV) infection between April and June 2023. TDR and molecular transmission networks were analyzed based on partial pol sequences via the Stanford HIV drug resistance database and HIV-TRACE, respectively. Logistic regression was utilized to identify factors associated with TDR. Results HIV drug resistance genotyping was successfully performed on plasma samples from 6654 individuals. The overall TDR prevalence was 11.4% (95% confidence interval [CI], 10.6%–12.2%). Resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was 7.9%, 0.8%, 2.4%, and 1.0%, respectively. TDR to efavirenz/nevirapine (EFV/NVP) was 6.5%. According to the surveillance drug resistance mutation list, the prevalence of TDR to total, NNRTIs, NRTIs, PIs, and INSTIs was 8.2%, 6.4%, 1.0%, 0.7%, and 0.4%. Multivariable analysis linked TDR to non-Han ethnicity (adjusted odds ratio [AOR], 1.45 [95% CI, 1.17–1.79]), unknown transmission routes (AOR, 2.56 [95% CI, 1.33–4.90]), and CD4 ≥500 cells/μL (AOR, 1.29 [95% CI, 1.05–1.58]). Higher education (high school or more) reduced TDR odds (AOR, 0.77 vs primary education). Conclusions TDR among people with newly diagnosed HIV in China exceeds 10%, with EFV/NVP TDR >5%. Timely monitoring of TDR and adjustment of ART regimens are essential to mitigate the impact of drug resistance on treatment efficacy.